Healthcare Provider Details

I. General information

NPI: 1285132373
Provider Name (Legal Business Name): MARY ELIZABETH NASVESCHUK PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARY ELIZABETH RODMAN

II. Dates (important events)

Enumeration Date: 01/24/2018
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11930 BOYETTE RD
RIVERVIEW FL
33569-5601
US

IV. Provider business mailing address

707 GRIFFEN HEIGHTS CT
RUSKIN FL
33570-2002
US

V. Phone/Fax

Practice location:
  • Phone: 813-671-1022
  • Fax:
Mailing address:
  • Phone: 619-992-8093
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT33243
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: